Post Tagged with: "Medicare"

The Balanced Budget Act of 1997 law attempted to use the SGR to substitute medical inflation with general inflation adjustments to the Medicare physician fee schedule. Since the costs of CAT scans have risen faster than cat food, Congress periodically had to pass catch-up “fixes.”

The Accountable Care Organization regulations were first promulgated under authority of the ACA’s Medicare Shared Savings Program in 2011. Three years later, the regs are in the shop for a tune-up. Farzad Mostashari MD was one of the authors of the Brookings Institution ACO issue brief released in the spring, suggesting some changes to the program that would keep current ACOs engaged past the end of their three-year contract term, and improving the program overall.

The transcript on whether to pay for medical homes reflects a wandering discussion with no final consensus. That being said, there were some interesting takeaways from a group of policy wonks who’ve spent a lot of time thinking about this approach to care.

The Sustainable Growth Rate mechanism creating a zero-sum game for Medicare Part B reimbursement rates (dropping rates as volume picks up) has long been unsustainable, and so Congress has been messing around with short-term SGR fix legislation for years now.

According to this just-released report from the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG), “copy-pasting” and “overdocumentation” are increasing the rates of Medicare fraud.

United HealthCare and other Medicare Advantage plans are dropping numerous providers from their networks, to the consternation of members given short notice of the changes. Predictably, the story is presented as big bad insurance co. vs. grandma, but the real story is less clear-cut.

If you’re interested in a post-mortem of Dr. Donald Berwick’s failure to be confirmed as CMS Administrator, check out his November 13 JAMA article on “The Toxic Politics of Health Care.” He identifies six causes of our national discontent.

Our updated numbers for lifetime Social Security and Medicare benefits and taxes are now available, based on the latest projections from the Social Security and CMS actuaries for the 2013 trustees’ reports for OASDI and Medicare.

The ACA mandates that a patient’s eligibility for the Medicare Home Health benefit rely upon a documented face-to-face encounter between a patient and physician. Lets question the potential impositions and reflect on how best to utilize limited resources in bringing a desired result.